经口置入钉砧头系统在腹腔镜辅助下高位贲门癌根治术中的应用

Transorally inserted anvil ( OrVil) in laparoscopic resection of high cardiac carcinoma

目的探讨经口置人钉砧头系统（OrVil）在腹腔镜高位贲门癌（贲门癌累及食管下段）根治术消化道重建中的应用经验。方法回顾性分析OrVil完成腹腔镜辅助下高位贲门癌根治术21例患者临床资料，肿瘤均位于贲门部并累及食管下段，肿瘤上缘距门齿平均距离38cm。结果21例患者手术均获成功，无手术死亡病例及严重并发症发生。手术平均时间280min，术中平均出血250ml，术后第3～5天可通过胃管进流食，术后第10天左右可出院。除1例患者发生胸腔感染经过治疗痊愈出院外，其余患者在住院期间及出院随访至今均未出现并发症。结论利用经口置人OrVil砧头系统完成贲门癌根治术后消化道的重建吻合是一种高效、安全、直观、微创的吻合方式，可以在有条件的医院开展。

Objective To explore the technique and effect of applying new type stapler（OrVil） for laparoscopic cardiac carcinoma resection. Methods From Nov. 2010 to Feb. 2013,21 patients （ 15 men and 6 women, mean age 67 ＋ 3.52 years, ranging from 52 to 82 years） underwent laparoscopic resection with OrVil in our hospital. Among the patients, the tumor was located at cardiac region with carcinoma invasive the lower esophagus. The mean length of the tumor to incisor was 38cm（ ranging from 36cm to 40cm）. Results All surgeries were successful with no death or serious complications. The mean operation time for 21 patients was 280min （240min -535min）. The mean blood loss during operation was 250ml （200ml -350ml）. All the patients received liquid diet 3 to 5 days after the operation. The mean hospi- tal stay was 10 days. Except for 1 case of thoracic infection after treatment who was well -healed, the others had no complications during the hospitalization and follow - up period. Conclusion The application of new type stapler（Orvil） for laparoscopic cardiac carcinoma resection is safe and feasible with microinvasion. Thus, it can be applied clinically.